These health situations should be referred for a consultation with a physician or nurse midwife.
Rubella contracted in the first or second trimester;
Maternal anemia low iron (hemoglobin less than ten, hematocrit less than 30) that is not coming up to a normal level within within one month of treatment;
Baby has very little water. Oligohydramnios (suspected);
Baby has a lot of water around him/her polyhydramnios (suspected);
Water breaks prematurely at less than 36 1/2 weeks;
Pregnancy goes post term at 42 weeks by dates and physical exam;
Mother is measuring large for her weeks along. (Large for gestational age (LGA) or small for gestational age (SGA))
Mother has antibodies in her blood, Rh sensitization in present pregnancy (not resulting from recent Rhogam injection);
History of severe bleeding after baby was born, requiring transfusion;
Known serious maternal viral/bacterial infection at term;
Blood pressure greater than 140/90 or increase of 30 mm Hg systolic or 15 mm Hg diastolic over baseline, that is unresolved within seven days;
Develops signs and symptoms of preeclampsia; Swelling in face, high blood pressure and rising, ringing in ears, “seeing stars”, severe headache, feeling sick.
Develops signs and symptoms of gestational diabetes; Elevated blood sugar levels over 140. Extra water around baby, measuring large for dates.
Unresolved vaginitis that requires antibiotic treatment
Unresolved urinary tract infection that needs antibiotics
Continued vaginal bleeding before onset of labor
Signs of fetal distress including prolonged fetal tachycardia (more than 170/minute) or prolonged fetal bradycardia (less than 100 beats per minute), or fetal demise;
History of preterm delivery (less than 36 1/2 weeks);
Positive maternal diagnosis of HIV;
Abnormal Pap smear (showing atypia or CIN);
All vaginal warts (condylomas)
Grand multiparity, mother having her 5th or more child
Maternal age less than 16 or greater than 40;
History of previous stillbirth;
History of incompetent cervix;
History of previous birth with baby acquiring Erb’s Palsy or fractured clavicle or humerus;
History of neonatal anomaly;
History of previous cesarean birth.